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Old 06-28-2013, 11:57 AM   #1
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Nerve pain in heel/toe after ankle surgery

Hi all--I'm new. :-)

I had ankle surgery to repair my medial malleolus back on May 8. It was fairly routine--just 2 screws. I was in a cast for a week, then was put into a boot but told to treat it like a cast--NO weightbearing for 7 weeks, keep the boot on 24/7 unless in the bathtub. I followed directions religiously.

I did notice that when I pressed on certain areas of the foot, I would feel a sharp pain. This occurred in the heel (from the bottom), toes (again, from the bottom, primarily the foot pad below the pinky, second, and 4th toes). When I asked the doctor about this, he said (around week 5) that it was just because I hadn't been using the foot.

The problem persisted, and this week, week 7, I was cleared to start partial weight-bearing--walking in the boot while taking approximately 1/2 the weight off my foot via the crutches. I don't have ankle pain to speak of (or at least, not often and only if I overdo it), but I have terrible shooting pains in my heel and toes as I step. It's OK if I take most of the weight on the crutches, but as soon as I go to more than just a little weight on the boot, the pain starts.

This week I also started PT and the therapist told me this is nerve pain--not uncommon after surgery (don't know why the doctor couldn't have told me this, but OK). I couldn't get much of an idea from her how long this will persist or if there is anything I can do about it.

I'm doing my ankle and leg exercises (those are mostly non-weightbearing at this point) and they are going great. The ankle is clearly healing well. But I don't see how I can progress to full weight bearing (supposed to try that next week!) when much more than a little pressure on the foot results in this nerve pain!

Help! Does anyone have experience with this? Is there anything I can do to speed things along? I need to return to my second job (barefoot hoof trimming for horses--how I broke the ankle!) ASAP and I'm fearful this will slow my progress to a crawl! The doctor is useless.

Thanks! :-)

 
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Old 07-01-2013, 06:34 AM   #2
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Re: Nerve pain in heel/toe after ankle surgery

Wow--no one??

The neuromuscular therapist I spoke w/ on the phone last week (this is some kind of specialized massage therapy) says she doubts it's nerve pain, but more likely related to the atrophy in my calf--related to the posterior compartment of the calf. ?? Any thoughts on this?

I have an appt w/ a better doctor tomorrow-I detested my surgeon and finally, after getting fed up w/ his half-assed answers, requested a new one.

Last edited by pawsplus; 07-01-2013 at 06:36 AM.

 
Old 07-01-2013, 11:32 AM   #3
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Re: Nerve pain in heel/toe after ankle surgery

I have had nerve pain associated with the trauma of surgery, however mine has been located in the top of my foot located between one of the ports and the end of the fourth and fifth toes. There is a sensory nerve that runs in that same area and frequently sustains some trauma during arthroscopic surgery, however this is a completely different location than your pain. It is often a common symptom to feel various aches and pains following surgery when you begin to to "new" activities such as bearing weight, switching from cast to boot and boot to shoes etc. at each new event your foot is having to sustain progressively more weight as well as requiring more strength and tissue power to maintain increasing degrees of stability. My PT has told me to expect aches and pains to pop up throughout the next 6 months to a year. And that I will have to slowly and methodically work through them. If however the pain be ones such that it does not calm down with conservative treatments or is very sharp and prolonged in nature that I should call the surgeon and consult with him.

This past weekend I tried a couple of "new" things since surgery and while I did not experience pain with the new events themselves, I did later have pain following the activities later in the day but after resting, icing and elevating I was good to go again the following day.
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Old 07-01-2013, 11:45 AM   #4
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Re: Nerve pain in heel/toe after ankle surgery

Thanks. Yeah, I expected a little pain, but this is very sharp and completely prevents me from bearing weight, which I am supposed to be able to do this week. I'll see the new guy tomorrow (also a surgeon, but not the *&%(&& who did the surgery) and I'll see what he says.

<sigh> This whole thing has just been awful. I managed to make it to 50 without every breaking a bone, being hospitalized, having any kind of surgery, or even having a cavity, and I guess I'm just not used to this. I suffered mightily during the 7 weeks of no weight bearing and was really looking forward to finally making progress. Now I find that dead in the water. I really need to get back to my second job (hoof trimmer for horses--how I got this stupid injury!) SOON!!!

 
Old 07-06-2013, 05:09 AM   #5
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Re: Nerve pain in heel/toe after ankle surgery

Newleftside, Thank you for this post. I posted a question, for an answer on a board and by browsing this one you answered it here!!! I have been going through this "nerve pain". It has been becoming progressively worse. Started in my 4-5 th toes and now has spread up to just above my ankle. Feels like I have burns on my foot. Slight touch hurts. I even have some noticeable temperature differences between the two feet. Blotches have been recent changes as well. I'm concerned now as I am reliant on my Norco so that I can walk about for the 4-5 hour time allowed by the Norco. Hubby said call OS Monday. Have you experienced any of this? I sure appreciate your help.

 
Old 07-06-2013, 05:03 PM   #6
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Re: Nerve pain in heel/toe after ankle surgery

I had the burning pain with the slightest touch causing me excruciating pain immediately following surgery until about 4 or 5 weeks post surgery when the burning sensation started to calm down and slowly the pain with touch changed to more of an electic tingle sensation. I did not have a noticeable temperature difference, I did have some purplish blotchy patches in my foot and ankle area when my foot was down and when I first started PT.

I would suggest a call to your OS to make sure you are not having an issue that needs to be followed up though. It is always better to be safe than sorry. I hope all goes well with your recovery. I am now 14 weeks post op and am nearly done with PT. I have been walking 3 miles /day for the last few days and went to the beach today with high surf. I am feeling it tonight and will need pain meds in order to get some sleep, but overall I am doing so much better.
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Old 07-08-2013, 02:39 AM   #7
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Re: Nerve pain in heel/toe after ankle surgery

I was left with my sural nerve being embedded in scar tissue on the outside of my ankle from my surgery. The pain lessened, but if I ever touch it, or putting on a sock or shoe I feel electrical sensations in that part of my foot. I was told I would always have this.
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Old 07-08-2013, 07:52 AM   #8
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Re: Nerve pain in heel/toe after ankle surgery

Right now everyone seems to think that the problem is plantar fasciitis and/or Achilles tendinitis secondary to the ankle surgery. The good news is that it's SLOOOOWLY getting better. Way too slowly for ME, but I guess I can't complain.

Last week I couldn't even contemplate walking w/ one crutch but over the weekend that became possible. PT is stepping up and concentrating more on stretching the Achilles and doing calf raises on the leg press machine (with very little weight, which is all I can handle).

I'm icing the Achilles and plantar fascia several times a day and doing roller exercises on the fascia. Fingers crossed!

 
Old 07-08-2013, 08:02 PM   #9
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Re: Nerve pain in heel/toe after ankle surgery

I am glad to hear that you are making progress and that you are experiencing less pain from what it sounds like. Keep up the PT exercises and faithfully do your home exercises as well. Before you know it this will be but a bad memory and you will be moving on to bigger and better challenges. Best of luck to you.
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Old 07-09-2013, 09:49 AM   #10
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Re: Nerve pain in heel/toe after ankle surgery

Has anyone out there experienced this degree of pain NOT associated w/ the actual surgery? I.e., uncomplicated medial malleolus repair surgery 9 weeks ago--it's healed up FINE. But this pain in my heel area is really intense. The increased PT has made it worse--is that normal??

I'm trying to get the stupid doctor to call me back. Should I get a referral to a podiatrist? Should I just suck it up and work through the pain? I'm willing and able to do that but am terrified of making things even worse, and since I can't seem to get the same "diagnosis" from any 2 people, I'm not entirely convinced about that course of action. It feels as if my heel area is going to explode when I put much weight on it/do the exercises the PT guy wants me to do.

I've never heard of anyone having these issues after relatively simple surgery for a broken ankle. I am 50, but I am in great shape, am thin and super healthy, was formerly very active, etc. I don't understand why this is happening!

 
Old 07-09-2013, 10:11 AM   #11
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Re: Nerve pain in heel/toe after ankle surgery

Stay away from podiatrists. You have to find OS who will be able to identify the reasons for your pain. I am in the same painful situation and in my case it is a pinched nerve. Physical therapy won't help. Find a smart doctor.

 
Old 07-09-2013, 10:28 AM   #12
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Re: Nerve pain in heel/toe after ankle surgery

Quote:
Originally Posted by Annie7679 View Post
Stay away from podiatrists. You have to find OS who will be able to identify the reasons for your pain. I am in the same painful situation and in my case it is a pinched nerve. Physical therapy won't help. Find a smart doctor.
What is OS?

What is wrong w/ podiatrists? There are some in the same ortho practice as the surgeon. This is a different surgeon than did the surgery--original one was horrible so I ditched him. New one is better. But I assumed that since he's a surgeon he would not be as up on things OTHER than surgery. Is this wrong?

 
Old 07-09-2013, 10:29 AM   #13
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Re: Nerve pain in heel/toe after ankle surgery

And in your case--pinched nerve--doesn't that hurt ALL the time? This perfectly fine unless I'm trying to walk on it.

 
Old 07-09-2013, 11:21 AM   #14
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Re: Nerve pain in heel/toe after ankle surgery

If your orthopedic Surgeon (OS) is board certified for foot and ankle, then he should be up to date on everything to do with the foot and ankle area. If you are seeing a surgeon that does not specialize in foot and ankle care he may or may not be as up to date with the specifics of foot and ankle, but he will still know enough to be able to diagnose what is causing your heel pain. Podiatrists usually only really work with foot specifically below the ankle. That is what I have found to be the case. I have had good and bad from each type of doctor.
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Old 07-09-2013, 11:43 AM   #15
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Re: Nerve pain in heel/toe after ankle surgery

The podiatrist that did my botched surgery told me that it takes a year for the pain to go away and everything is fine. My foot and ankle orthopedic surgeon explained to me what was wrong with my surgery. I had several problems, and one was neuritis, which is nerve pain as the result of misalignment of the bones. I do not have pain sleeping, pain when moving.

 
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